[Risk factors and clinical features of the course of recurrent acute otitis media in children]

This article discusses the problem of recurrent acute otitis media (RAOM) in children.

OBJECTIVE

To study the risk factors and the clinical course of RAOM in children.

MATERIAL AND METHODS

148 children (81 boys and 67 girls) from 1 to 14 years old were examined with a diagnosis of recurrent otitis media. The work was carried out in the ENT departments of Pediatric Clinical Hospital No. 13 named after N.F. Filatov, Pediatric Clinical Hospital named after Z.A. Bashlyaeva. The average age of the children was 4.1±1.5 years.

All children underwent a clinical study, a laboratory study on the content of the main metabolite of vitamin D - 25(OH)D₃ (25-hydroxyvitamin D, or calcidiol) in blood serum.

RESULTS

Our clinical examination of children with RAOM allows us to identify the main risk factors for this pathology. Thus, the most significant risk factors for the development of RAOM in children included in the study were: early visits by children to preschool institutions (50.6%), allergic history (39.1%), pathology during pregnancy (28.3%), mixed (38.5%) or artificial (27.7%) feeding in the first year of life, frequent upper respiratory tract diseases (41.2%), burdened heredity in close relatives according to RAOM (33.7%), smoking in the family of one of the parents (65.5%) presence in the family of one more child (34.4%).

CONCLUSION

It was shown that the absolute number of children (96%) with RAOM is characterized by a reduced level of 25(OH) vitamin D in the blood serum, which can increase the likelihood of developing episodes of acute otitis media in children and requires therapeutic correction.

[Unilateral subjective tinnitus «vanishing bone» disease (Goram-Stout syndrome).]

The article presents the case history of an 11-year-old girl with Goram-Stout disease, who debuted with unilateral subjective tinnitus. A review of the literature, cases with damage of the temporal bones and modern methods of treatment of this disease is made.

[Topical drugs for the treatment of non-streptococcal acute tonsillopharyngitis in children: results of a multicenter study]

INTRODUCTION

Acute tonsillopharyngitis (ATP) is a very common disease in children. In non-streptococcal ATP, systemic antibiotics are usually not indicated, but topical antimicrobial therapy is advisable.

OBJECTIVE

To evaluate the effectiveness of the combination of cetylpyridinium chloride with gramicidin C in the form of a spray in children with ATP in a prospective multicenter non-interventional study.

Patients and methods. The study included 94 patients aged 6-15 years with non-streptococcal ATP. A standard examination, assessment of the pain intensity in the throat using a visual analogue scale, assessment of the pain frequency during swallowing and a score assessment of objective manifestations were carried out. Sixty-eight patients of the main group received a combination of cetylpyridinium chloride with gramicidin C (Grammidin for children) in the form of a spray, 26 patients of the control group received throat irrigation with saline solution (based on sea water) for 7 days. Therapy was assessed after 1 day (by phone), 4 and 8 days (by examination).

RESULTS

The groups of patients did not differ significantly in terms of demographic indicators and initial clinical manifestations. Body temperature initially did not differ, but was significantly lower in the main group after 1 (p=0.003) and 4 (p=0.04) days. The sore throat pain intensity decrease in the main group significantly exceeded this indicator in the control group after 1 (p<0.001) and 4 (p <0.001) days. Initially, swallowing pain was observed in all patients, after 4 days the complaint was significantly less frequent in the main group (p<0.001). The total assessment of objective data was significantly lower in the main group after 4 (p<0.001) and 8 (p<0.001) days. No adverse effects of pharmacotherapy were observed.

CONCLUSIONS

The study showed high efficacy and safety of the cetylpyridinium chloride and gramicidin C (in the form of a spray) combination for non-streptococcal ATP in children aged 6-15 years.

[Hypertrophy of palatine tonsils - possible treatment approaches]

OBJECTIVE

To evaluate the effectiveness of different approaches to the treatment of patients with hypertrophy of the palatine tonsils (HPT).

MATERIAL AND METHODS

90 children with HPT of II-III degree and 20 healthy children (group 1) aged from 3 to 7 years were included in the study. Children with HPT were divided into three groups: group 2 - children who underwent tonsillotomy (n=30), group 3 - children who underwent conservative treatment, including only topical use of Polyoxidonium (n=30), group 4 - children who underwent complex treatment (tonsillotomy with subsequent local use of Polyoxidonium), (n=30). The severity of nasal breathing disturbances on a visual analogue scale, the average number of acute respiratory viral infections 6 months before and after treatment, the level of gene expression of antimicrobial peptides before and after treatment, the degree of hypertrophy of the palatine tonsils and spleen with an assessment of the echostructure and determination of the spleen mass coefficient using Ultrasound were evaluated in the study.

RESULTS

In children receiving only Polyoxidonium, there was a decrease in the severity of nasal breathing disorders, a decrease in the frequency of acute respiratory viral infections, an increase in the expression of antimicrobial peptide genes compared to the initial level of these indicators. Comprehensive treatment of children with HPT (group 4) showed a significant decrease in the severity of nasal breathing disorders, a decrease in the average number of acute respiratory infections within 6 months, an increase in the expression of antimicrobial peptide genes compared to children who underwent only tonsillotomy (group 2) or only conservative therapy (group 3).

CONCLUSION

It is proved that the use of Polyoxidonium in the complex treatment of HPT is clinically effective and safe.

[Balloon sinuplasty in children - Russian first experience]

AIM

To evaluate and compare the clinical outcome and impact of balloon sinuplasty and functional endoscopic sinus surgery (FESS) on the quality of life of pediatric patients and adolescents suffering from chronic rhinosinusitis (CRS).

MATERIAL AND METHODS

A retrospective study was performed of 47 children with failed medical therapy, who were scheduled for surgery. The first one pediatric balloon sinuplasty was performed by Ilya Zyabkin in Filatov Children's City Hospital on the 30-th of August 2012.They underwent treatment by balloon sinuplasty of selected sinuses in 553% (n=26) cases and hybrid FESS with BSP - in 44.7% (n=21). Data were collected, including perioperative CT Lund-Mackay score and SN-5 quality of life findings.

RESULTS

Compared with preoperative values, Lund-Mackay scores were significantly lower at 1 year (p<0.05) in 92,3% (n=12) patients after surgery. Moreover, balloon sinuplasty improved sinusrelated quality of life score in 93.3% (n=42) patients for up to 1 year after operation (p<0.05).

CONCLUSION

Balloon sinuplasty showed a clinical curative effect in the treatment of children and adolescents with refractory CRS, and was relatively safe by itself. BSP allows to postpone, if necessary, FESS or avoid circular mucosal trauma and infundibulotomy in hybrid FESS with balloon sinuplasty technique.

[Possibility of treatment chronic adenoiditis and otitis media with effusion in children, into account the role of the microbiota of the mucous of the nasopharynx]

In recent years, OME in childhood tends to increase. The low efficiency of the currently used traditional methods of conservative therapy and the high rate of relapse of the disease make it necessary to develop new methods of treatment. It is important that there is a connection of development of OME and hypertrophy of the lymphoid tissue of the nasopharynx, which in childhood is considered as a response to the respiratory antigenic virus-bacterial load. The spread of the inflammatory process to the auditory tube with persistence of pathogenic microorganisms in the structure of lymphoid tissue leads to the further development of otitis media effusion; but it is still debatable. All living microorganisms that inhabit a certain anatomical niche (viruses, bacteria, fungi, etc.) are called 'microbiota'. This term includes both commensals and pathogens. 'Microbiome' means the totality of all genes of all microorganisms that inhabit the study area. Thus, the microbiome can be called the collective microbiota genome. Microbiota disorder is a change in the quantitative and qualitative composition of microorganisms, called dysbiosis, and is important in the development of inflammatory pathology. Some drugs (including antibacterial ones) adversely affect indigenous bacteria. Indigenous microbiota develops in abundance in the observed biotope and forms resistance to excessive growth of pathogenic microorganisms. Only NGS sequencing allows to analyze entire mixed bacterial communities ('microbiomes'), which cannot be performed by other diagnostic methods. The use of the NGS sequencing method has proved the important role of microbiota in the development of chronic adenoiditis and OME in children. One of the promising remedies is the inclusion of lysozyme in the treatment regimen. Recent studies indicate the antibacterial and antiviral effects of lysozyme. The use of NGS sequencing made it possible to identify the relationship of the composition of microbiota with the course of chronic adenoiditis and otitis media effusion in children. Inclusion of lysozyme-containing drug Lizobact into therapy promotes colonization of the nasopharynx by indigenous microbiota, while the clinical picture improves.

[About the safety of application of nasal decongestants in the practice of pediatricians]

Undesirable effects of the application of the intransal vasoconstricting medications are a frequent occurrence in the pediatric practice. The objective of the present study was to evaluate the role of the intranasal vasoconstricting medications in the structure of the means and methods currently available for the treatment of toxicological pathologies based at a multi-field clinical hospital. The retrospective analysis of the medical histories of the patients admitted to the toxicological department and annual reports for the period from 2015 to 2016 was undertaken. The study has demonstrated that intoxication associated with the use of the intranasal vasoconstricting medications was the most common cause of hospitalization of the children in the toxicological departments. Intoxication of this origin accounted for 15-20% of the total number of toxicological pathologies among the children. The cases of intoxication are most frequently documented in the group of children at the age between 1 and 3 years. The risk of the undesirable serious complications is especially high after the application of naphazoline-based intranasal vasoconstricting medications (71.7-77.4% of all the cases of intoxication with these products). It is concluded that the use of intranasal vasoconstricting medications in the pediatric practice should be carried out under the strict control, with the naphazoline-based preparations being totally excluded from the application.

[Possibilities of treatment of inflammatory pathology of the nasopharynx in children with chronic adenoiditis and otitis media with effusion]

The purpose of observation is to increase the effectiveness of treatment of children with chronic adenoiditis and exudative medium otitis. MATERIAL AND METHODS: In the observation were included 102 children with exudative medium otitis and chronic adenoiditis at the age of 3 to 14 years. All patients passed clinical and anamnestic diagnostic, endoscopic study, study of the nasopharynx, and PCR diagnostics of the stroke of the mucous membrane of the nasopharynx. The treatment was conducted, taking into account the patient's age, in the design of a simple randomized follow-up. RESULTS: In a nasopharynx children with chronic adenoiditis and exudative medium otitis revealed a predominance of viral and bacterial associations; among viruses, rhinovirus and adenovirus occupy a leading place. Effective complex conservative treatment was developed with the use of the Lysobact, which helps to reduce the frequency of prescribing antibacterial therapy. The use of lysozyme is one of the promising areas of treatment of chronic adenoiditis and exudative medium otitis.

[The application of different non-steroidal anti-inflammatory drugs for the elimination of pain syndrome during the early postoperative period in the children following the surgical interventions on palatine tonsils]

The present clinical study included 120 children at the age varying from 6 to 18 tears who had undergone radiowave tonsillotomy followed by symptomatic therapy during the early postoperative period with the application of different non-steroidal anti-inflammatory drugs. All the patients were randomly allocated to four groups each comprised of the equal number of patients. Those of group 1 were treated with ketoprofen lysine salt (КLS) in the form of a solution for oral intake in case of complaints of severe pain in the throat. The patients of group 2 received courses of ketoprofen lysine salt therapy per os thrice daily during 3 days after the surgical intervention. The patients of group 3 were given ibuprofen per os up to three times every day in case of complaints of severe pain in the throat. The patients of group 4 were treated with ketoprofen lysine salt in the form of a solution for the local application twice daily during 3 days after the surgical intervention. The results of the analysis with the use of the analog-visual scale have demonstrated that a decrease in pain intensity within 24 hours after surgery was much more pronounced in the patients of group 2 in comparison with those of the remaining three groups (р<0.05). The difference of pain intensity in the throat evaluated based on the analog-visual scale between the patients of groups 1, 3, and 4 was insignificant (p>0.05). None of the children exhibited the signs of bleeding throughout the entire observation period. It can be concluded that a course of therapy with the use of ketoprofen lysine salt for oral intake during the early period after the surgical intervention for radiowave palatine tonsillotomy has some advantages over a single intake of the analogous preparation (for alleviation of strong pain in the throat), an ibuprofen syrup or a ketoprofen lysine salt solution for throat wash.

[The possibilities for the rational pharmacotherapy of adenoiditis in the children]

The available literature data give evidence that viral infection is the main cause underlying the development of inflammatory nasopharyngeal pathology in the children. According to ICD-10, nether acute nor chronic adenoiditis should be considered as a self-consistent nosological entity. Acute adenoiditis is usually regarded as a form of acute nasopharyngitis (J02) or acute respiratory viral infection (J06.9) whereas chronic adenoiditis is commonly referred to as representing other chronic diseases of the tonsils and adenoids (J 35.8). The reactive changes in the nasopharyngeal tonsils begin to be manifested on days 3-5 after the onset of acute respiratory viral infection; thereafter, they persist and gradually disappear within the next 2-3 weeks. In the majority of the cases, acute adenoiditis is actually a physiological reaction of the nasopharyngeal tonsils as the organs of regional mucosal immunity to antigenic stimulation. There is no universally accepted opinion as regards the duration of the inflammatory process which would allow these pathological changes to be considered as turned into chronic ones. This condition is actually not a serious pathology provided it is not associated with the concomitant complications and produces no clinically significant effect on the child's quality of life. Under practical conditions, such children are most frequently treated with the use of irrigation therapy. Taking into account that otorhinolaryngologists all over the world do not consider chronic adenoiditis as an independent nosological entity but distinguish only hypertrophy of adenoid vegetations or chronic rhinosinusitis (in the presence of inflammatory changes in the nasopharynx), it appears correct to speak about chronic adenoiditis provided the clinical manifestations of the disease persist for more than 12 weeks. Based on the predominant etiological component, the viral, bacterial, and allergic forms of nasopharyngeal adenoiditis can be distinguished even though it is rather difficult to actually determine which etiological factor prevails in each concrete case. The aforedescribed situation poses a large number of questions pertaining to the choice of either systemic or topical antibacterial therapy.

[Genetic variation of the mtDNA cyt b locus in topmouth gudgeon introduced into water bodies in the northern part of the Black Sea region]

The up-to-date phylogeographical distribution of the topmouth gudgeon Pseudorasbora parva Temminck et Schlegel 1846 in water bodies of the Northern Black Sea region is considered. Genetic variation of mtDNA cyt b gene is analyzed. It is established that topmouth gudgeon penetrated and spread in the basins of the Dnieper and Don rivers and in water bodies of Crimea from the secondary center of its dispersion— water bodies of Central Europe. It is demonstrated that haplotypes of topmouth gudgeon in the Danube delta are the most homologous to the haplotypes in the native range of the species in China. A considerable decrease in the level of genetic variation in the populations in the Black Sea region is reported.

[Polypous rhinosinusitis in the children]

We present an overview of the modern literature concerningpolypous rhinosinusitis (PRS) in the children. The information thus derived is compared with the available results of the clinical investigations involving the adults patients with this pathology. Allergic diseases and mucoviscidosis appear to be the pathological conditions most likely leading to the development of polyps in the nasal cavity. The patients suffering from rhinosinusitis associated with the disorders of arachidonic acid metabolismare very rarely encountered in the pediatric practice unlike those among the adult population. Intranasal glucocorticosteroids (INGCS), especially in the form of the mometasonefuroate nasal spray, are considered to be the most promising medications for the treatment of the children presenting with PRS. However, further clinical studies are needed to confirm the effectiveness and safety of this therapeutic modality.

[Prophylaxis of chronic adenoiditis in the children]

This study was undertaken with the purpose of improving the effectiveness of the preventive treatment of chronic adenoiditis in the children. The open randomized comparative study included 219 children aged from 6 to 7 years presenting with clinical and anamnestic signs of chronic adenoiditis. The study group was comprised of 113 patients given the Streptococcus salivarius K12-based probiotic complex during 30 days in combination with the nasal-douche. The control group consisted of 106 patients treated with the nasal douche alone. The analysis of the results of the study has demonstrated that episodes of exacerbation of adenoiditis on day 30 after the onset of the treatment occurred in 56 (49.6%) children of the study group compared with 95 (88.7%) patients of the control group. Three months later, acute sinusitis was diagnosed in 4 (3.5%) children of the study group compared with 14 (13.2%) ones in the control group. Acute otitis media was documented in 2 (1.8%) and 5 (4.7%) children of the study and control groups respectively. It is concluded that the treatment with the use of the Streptococcus salivarius K12-based probiotic complex permits to decrease the frequency of exacerbations of chronic adenoiditis and its complications in the children and reduces the requirement for medication therapy.

[Use of Myrtol standardized in the treatment of children with acute rhinosinusitis]

The present study included 60 children at the age from 6 to 10 years undergoing a course of out-patient and in-patient treatment of acute rhinosinusitis (ARS). Thirty of these patients were given Myrtol standardised in the dose of 120 mg thrice daily for 7 days, in addition to traditional therapy.With convincing objective data for acute bacterial rhinosinusitis (in accordance with the criteria of EP3OS 2012), antibacterial preparations were prescribed to the children. The remaining patients received either conventional (symptomatic, irrigation) therapy or systemic antimicrobial agents. The analysis of characteristics of the visual-analog scale reflecting the severity of rhinorrhea, basal congestion, and coughing has demonstrated a significant (р<0,05) difference between the two groups of children in terms of manifestations of the clinical symptoms within days 7 and 14 after the onset of the treatment. For basal congestion, the difference was apparent as soon as day 3 after the beginning of therapy. The duration of the treatment with intranasal vasoconstrictive medications used for symptomatic therapy by the patients given Myrtol standardized was 2.2±0.4 days in comparison with 3.6±0.5 days in the control group. None of the patients treated with GeloMyrtol exhibited any adverse reaction attributable to the action of the medication in being studied. The study has demonstrated that using Myrtol standardized for the treatment of the uncomplicated forms of acute rhinosinusitis in children is clinically effective, safe, and convenient method for the management of ARS in children. And it can be recommended for the wide practical application.

[Immunoprophylaxis of infections of the upper respiratory tract in the frequently ill children]

The review of the clinical studies designed to evaluate the prophylactic effectiveness of ribosomal immunization is presented. It is shown that the application of the ribosomal vaccine ribomunyl causes a significant reduction in the occurrence of acute respiratory infections in the frequently ill children, lowers the frequency of exacerbation of chronic diseases of the upper respiratory tract, and allows to decrease the use of antibiotics. The authors emphasize the high therapeutic effectiveness and safety of preventive measures against respiratory infections in the frequently ill children with the use of the anti-influenza vaccine in combination with ribosomal immunization.

[The possibilities for the treatment of exudative otitis media in the children presenting with chronic adenoiditis]

The objective of the present study was to improve the effectiveness of medicamental therapy of exudative otitis media in the children with recurrent and chronic adenoiditis. It was shown that the use of fluifort (carbocysteine lysine salt) for the treatment of exudative otitis media in the children presenting with chronic adenoiditis is a more effective approach in comparison with the expectant management. It is concluded that the application of carbocysteine lysine salt in combination with the mometasone furoate nasal spray ensures the rapid elimination of the symptoms of adenoiditis and significantly accelerates the resolution of exudative otitis media compared with the monotherapeutic treatment.

[Halitosis concomitant with chronic ENT pathology in children]

The objective of the present study was to estimate the potential of gas chromatography as a tool for diagnostics of chronic ENT pathology in the children. A total of 37 patients aged between 5 and 18 years with chronic ENT diseases and complaints of foul breath were available for the examination. Thirty one children presented with chronic tonsillitis, 3 with chronic adenoiditis, 2 with chronic rhinosinusitis, and 1 with subatrophic rhinitis. It was shown with the use of gas chromatography that the exhaled air from 34 (91.9%) patients contained cadaverin at a concentration of 0.004-0.0009 mg/ml. Three (8.1%) children exhaled methyl mercaptan (0.01-0.025 mg/m3) and hydrogen sulfide (0.002-0.006 mg/m3), and 2 (5.4%) patients exhaled the air containing dimethyl disulfide (0.009-0.002 mg/m3). The volatile sulfur-containing compounds were detected only in the children aged above 14 years. It is concluded that chronic tonsillitis is the leading etiological factor responsible for the development of the extraoral form of halitosis in the children. The foul breath in the children unlike that in the adults is most frequently due to the enhanced cadaverin concentration in the exhaled air rather than the production of volatile sulfur-containing compounds.

[Local therapy of infectious complications of allergic rhinitis in the children]

The objective of the present investigation was to estimate the effectiveness and safety of rinorin used for the prevention and treatment of infectious complications of allergic rhinitis in the children. A total of 70 children varying in the age from 5 to 15 years and presenting with the mild and moderate-to-severe form of seasonal allergic rhinitis were included in the study; they were divided into two groups. The study failed to reveal statistically significant difference between the groups in terms of adverse reactions to the treatment with rinorin. During the 21 day study period, infectious rhinitis was diagnosed in 2 (5.7%) children given rinorin compared with 5 (14.3%) ones in the control group (p>0.05). However, the patients of the latter group suffered a more severe form of this infectious complication of allergic rhinitis. It is concluded that rinorin is characterized by a high level of safety even though the antimicrobial potency of benzalkonium chloride, its active ingredient, needs further studies and evaluation.

[A novel view of prophylaxis and treatment of chronic adenoiditis in children]

The present clinical study had the objective to evaluate the role of a hypertonic solution of sterile water from the Adriatic Sea in the prevention and treatment of chronic adenoiditis in children. It included 30 children aged from 2.5 to 15 years. The control group was comprised of 30 children treated by intransal drop infusion of physiological saline followed by irrigation of the nasal cavity with framicetin as recommended by the manufacturer. The study failed to reveal a significant difference (P > 0.05) between dynamics of the symptoms of chronic adenoiditis in the patients of either group assessed based on the 10-point analog visual scale. However, the frequency of relapses of adenoiditis during the observation period (3 months) was significantly lower in the patients treated with the hypertonic solution of sterile seawater. Microbiological investigations of the material from the pharyngonasal cavity showed no difference between the occurrence of tansient bacterial microflora in the patients of the study and control groups.